Other benefits

Alcohol and Drug treatment

If you are on the Standard Care Plan and you or dependants require treatment for alcohol or drug dependency, you will need to register on the SANCA alcohol and drug dependency management programme.

After registration, you need to use the services of SANCA (The South African National Council on Alcoholism and Drug Dependence), as they are our Designated Service Provider (DSP). SANCA's management programme provides a set of guidelines for the management and treatment of alcohol and drug dependency, which includes hospitalisation, medicine and associated therapies. If you choose not to register on the SANCA programme, you may continue using your existing healthcare provider, but you will be responsible for a co-payment, which is payment for the difference between the amount your healthcare provider charges and the amount the Scheme would pay to SANCA for the services.

On registration, you will receive a detailed treatment plan indicating the services and medicine that are allowed, according to the SANCA protocols. To register on the programme, please phone 0860 222 633.

Out of hospital alcohol and drug treatment is limited to the Overall Out of Hospital Family Limit of R5 070 per adult, Child: R2 530 per child per year. Hospitalisation is limited to 21 days.

Hospice

Standard Care Plan funds hospice services instead of hospitalisation (in-patient care facility and out-patient home care). To obtain an authorisation call 0860 222 633. The Designated Service Provider to be used is Hospice. Subject to Scheme protocols.

Kidney disease

Anglo Medical Scheme manages renal (kidney) dialysis and transplants to ensure that the correct treatment protocols are adhered to and that members get the most cost-effective care. Should kidney failure occur, members need to ensure that their specialist contacts the Scheme to authorise a treatment plan. Once the application has been assessed and authorised, the appropriate treatment may begin. Standard Care Plan members need to phone the Scheme on 0860 222 633.

Organ transplant

The Scheme funds organ transplants in accordance with the organ transplant management programme. Call 0860 222 633 to register on the program and to receive authorisation. Cover includes the harvesting of the organ, post-operative care of the member and the donor and anti-rejection medicine. All costs for the organ donation for any person other than a member or registered dependant of the Scheme are excluded.

Oxygen therapy

If you have been diagnosed with chronic obstructive airways disease and require oxygen therapy, please contact the Call Centre on 0860 222 633 for more information.

The Scheme’s Designated Service Provider (DSP) for oxygen therapy is VitalAire. If you choose not to make use of VitalAire, you will be responsible for the difference in cost between your healthcare provider’s rate and the amount the Scheme would have paid to VitalAire.

Radiology

We fund all PMB radiology at 100% of the Scheme Reimbursement Rate (SRR) according to Scheme protocols.

Non-PMB out of hospital radiology is subject to an Annual Family Limit of: R1 680 per adult, R1 015 per child.
You are entitled to 100% of the SRR for radiology services and costs of materials. These include specialised radiology (i.e. MRI and CT scans, Isotope therapy, mammogram and one bone densitometry scan).

Bone densitometry scans are limited to one per beneficiary per year.
Call 0860 222 633 for authorisation.

Pathology

We fund all PMB pathology at 100% of the Scheme Reimbursement Rate (SRR) according to Scheme protocols.

Non-PMB out of hospital pathology is subject to an annual Pathology Family Limit of R 1 285 per adult, R460 per child per year. You are entitled to 100% of the SRR for pathology services and costs of materials.

The Scheme will not pay for DNA testing and investigations, including genetic testing for familial cancers and paternal testing.

Cancer screening tests

A male beneficiary is entitled to one Prostate Specific Antigen (PSA) screening test annually and a female beneficiary to one Pap smear (cervical cancer screening) from age 21 - 65, unless motivated by your doctor.

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